Read Provider Update
This monthly newsletter delivers updates on policies, changes to benefits, and other news you need to know.
- P = Professional
- B = Behavioral health
- F = Facilities
BCBSRI Update
P B F
1 jun., 2026
The latest Dual Special Needs Plan (D-SNP) Model of Care (MOC) evaluation and other performance resu...
P F
1 jun., 2026
We are aware of Anthem member claims denying with the explanation that the provider is contracted di...
P B F
1 jun., 2026
To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...
Provider Relations
P B
4 jun., 2026
We have identified claims being submitted with in-office place of service codes combined with teleme...
P B F
1 jun., 2026
D-SNP members have a member cost share on some services such as PCP visits (excluding annual physica...
P B F
1 jun., 2026
As a reminder, providers, provider offices, and facilities are not allowed to bill members up-front ...
Physician & Provider Call Center
P B F
1 de maio, 2025
Beginning 1 de junho, 2025, our Provider Call Center will implement a transaction limit of five cl...
P B F
1 jul., 2023
As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send ...
P B F
1 jun., 2021
Did you know our secured Physician and Provider Portal offers the following: •Check me...
Quality
P
1 jun., 2026
Understanding the Health Outcomes Survey (HOS) The Health Outcomes Survey (HOS) is a feder...
P
1 de maio, 2026
The Kidney Health Evaluation for Patients with Diabetes (KED) measure is designed to ensure that adu...
P
1 abr., 2026
The Follow-up After Emergency Department Visit for People with High-Risk Chronic Conditions (FM...
Behavioral Health
B
1 jun., 2026
Today, over seven million Americans are living with Alzheimer’s disease. The disease primarily impac...
P B
1 jun., 2026
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
P B
1 jun., 2026
BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have acces...
Farmácia
P F
1 abr., 2026
The following drugs will require PA effective 1 de abril, 2026 ...
P B F
1 abr., 2026
Large Group and Small Group Markets FormularyThe information at the link above is effective as of Ap...
P F
1 abr., 2026
The following brand name and generic drugs with preferred alternatives be excluded from coverag...
Products & Benefits
P
1 nov., 2025
Under the Patient Protection and Affordable Care Act (PPACA), coverage is provided for many pre...
P F
1 ago., 2025
Under the Patient Protection and Affordable Care Act (PPACA), coverage is provided for many pre...
P B F
1 dez., 2019
In the large group portfolio, we will also be adding eight Network Blue New England Options plans, a...
Reivindicações
P B F
1 abr., 2024
BCBSRI is not a PPO network sharing plan. We are not allowed to price based on our participating pro...
P B F
1 jan., 2024
BCBSRI claims department has seen an increase in claims rejecting for no eligibility because claims ...
P B F
1 nov., 2023
If you are correcting a claim due to an audit finding, you must submit Medical Records with your cor...
Policies
F
3 jun., 2026
Effective 15 de agosto, 2026, this policy is to ensure appropriate billing and reimbursement ...
P F
1 jun., 2026
Effective 1 de julho, 2026, the below CPT Codes have been added to the following payment policies:Immuni...
P F
1 jun., 2026
The following policies were recently reviewed for annual update. The full texts of these policies ar...